Percutaneous cholecystostomy for the treatment
of acute cholecystitis in the critically ill and elderly
JCM Li, DWH Lee, CW Lai,
ACN Li, DW Chu, ACW Chan
Department of Surgery, North District Hospital, New Territories
East Cluster, 9 Po Kin Road, Sheung Shui, Hong Kong
OBJECTIVE. To evaluate the clinical efficacy and
outcomes of percutaneous cholecystostomy as an alternative treatment
option for elderly and critically ill patients who have acute cholecystitis.
PATIENTS AND METHODS. The medical records of patients
who underwent emergency percutaneous cholecystostomy at the North
District Hospital, Hong Kong from September 1999 to July 2002 were
reviewed. Indications for the procedure, patient demographics, and
other clinical details were recorded.
RESULTS. A total of 25 patients (10 male, 15 female)
with a median age of 81 years (range, 39-97 years) presented with
acute cholecystitis and underwent percutaneous cholecystostomy with
ultrasound guidance. Two patients required emergency cholecystectomy
on day 1 after the procedures because of deteriorating conditions.
The rest of the patients clinically improved after drainage. There
was no major periprocedural complication, and four patients had
their catheter accidentally dislodged but did not require re-insertion.
There were five inpatient mortalities, although the majority of
these deaths were from unrelated illness. Subsequently, only six
patients underwent elective cholecystectomy, one open and five laparoscopic.
Two patients were offered percutaneous endoscopic
cholecystolithotripsy, one defaulted and the other could not tolerate
the procedure. Eleven patients declined further intervention due
to the high surgical risks, three of these patients developed biliary
symptoms, one had acute cholecystitis, and the other two had cholangitis.
The rest of patients had no symptoms related to the gallstones.
The median follow-up period was 81 weeks (range, 27-162 weeks).
CONCLUSION. Percutaneous cholecystostomy is a viable
treatment option for elderly and critically ill patients presenting
with acute cholecystitis. It has a high success rate with minimal
procedure-related complications. Elective cholecystostomy is the
treatment of choice for low-risk patients after the initial acute
Hong Kong Med J 2004;10:389-93
Key words: Cholecystectomy; Cholecystostomy